Vashon Family Practice, a busy clinic on the south end of town, temporarily closed its doors Monday after a state health law judge suspended Dr. Sjardo Steneker’s license for five years.

In a 19-page decision handed down Thursday, Judge Jerry Mitchell said Steneker was guilty of unprofessional conduct because of his relationships with five female patients. According to the judge, who issued the ruling after a five-day hearing in May, state prosecutors provided “clear and convincing evidence” that Steneker had sexual relationships with three of those women and made advances towards two others — actions not allowed under state rules that govern medical professionals.

Two other patients who had been part of the case were dropped from the state’s charges.

As a result, the family practice physician, who has had a practice on Vashon for 16 years and who opened his clinic at the building he owns seven years ago, will lose his license for five years and face a $5,000 fine. He can resume his practice after five years only if he undergoes a psychosexual evaluation and takes 32 hours of coursework in ethics and boundaries, the order states.

Steneker, a Dutch-born physician, has 30 days to appeal the order, which is effective immediately. His lawyer Bob Krinsky could not be reached for comment. In a brief statement, Steneker said he feels “an immense sadness” and is devastated by the decision.

“My largest concern is for my patients and the loss of continuity of care to my patients at Vashon Family Practice,” he added. “I will be working with my attorney, as soon as he returns from his vacation, and the appropriate authorities to establish as smoothly and as soon as possible transfer of care for all the patients at Vashon Family Practice.”

The decision could have a profound impact on Vashon’s medical world, because of both the size of Steneker’s caseload and the vulnerability of some of the patients he saw. According to his website, Steneker saw more than 3,000 patients, and according to some Island activists, a portion of his patients are among Vashon’s poorest and most vulnerable Islanders.

“My perception is that people who are low-income and in need of medical assistance and don’t have insurance go there,” said Nancy Vanderpool, who helps to head up the Interfaith Council for the Prevention of Homelessness.

Access to health care for Vashon’s low-income population is a serious issue on the Island, she said. “It’s definitely a problem that needs to be addressed, and this just makes it more urgent,” she added.

On Monday, some of Steneker’s patients were already trying to figure out where to turn in light of the ruling. A note on the door of the clinic said it was closed “due to circumstances beyond our control.” Later in the day, however, Dr. Nicole Maxwell, a naturopathic doctor who works at the clinic, posted a note on a Facebook page she created for the clinic, saying she would open Vashon Family Practice for several hours on Tuesday, Thursday and Friday.

“It’s a terrible blow for me,” said Phillip Ray Owens, 62, one of Steneker’s patients and a man who goes to the clinic twice a week for iron shots.

Owens said he first saw Steneker in 2007 “when I didn’t have a dime.” Owens showed up at the clinic with a broken finger, he said, adding, “The guy dragged me in there, sewed my finger up and didn’t say a word” about the bill.

“This guy has bent over backwards for me,” Owens added.

Other patients also expressed dismay. “I just don’t get the harsh punishment for basically a consensual thing,” said Denise Aberthal, who — along with her three sons — routinely sees Steneker. “I just don’t get it. … He loses his license and his livelihood, and the Island loses a good doctor.”

The standard sentencing range for such an infraction is a two- to five-year license suspension. Mitchell, the health law judge, decided to follow the state’s recommendation and issue a five-year suspension due to several factors, he said in his order, including “the intentional and repeated nature of the behavior; a pattern of misconduct over a lengthy period of time; prior discipline involving dishonesty …; and no remorse regarding his behavior.”

According to Mike Farrell, who heads the legal unit for the state Medical Quality Assurance Commission, “A five-year suspension is a very serious sanction to be imposed against a physician.”

Over the last three years, he said, 59 physicians in Washington — out of the state’s approximately 25,000 medical doctors — have had their licenses suspended or revoked or surrendered their license due to state action.

Under state law, medical doctors aren’t allowed to get sexually involved with patients — even if those patients are consenting adults — because of what Farrell called a power imbalance that exists between a doctor and a patient.

“Physicians have a greater degree of knowledge; they … make diagnoses. They treat patients. Information flows one way, from the patient to the doctor. The doctor has a lot of information about the patient, but the patient doesn’t have information about the doctor,” he said. “There’s just an imbalance of power in that relationship, … and the law provides protection to the public.”

Maxwell, meanwhile, said last week she planned to keep the clinic open and transition Steneker’s patients to her care and that of a nurse practitioner she hoped to hire. But on Monday, she said, she realized that she had many hurdles to overcome — from obtaining a business license to securing a loan — before she could take over the busy practice. Her husband Daniel Macca is in the process of getting an MBA and would help her run the practice, should the couple decide to take it on, she said.

“We don’t have the numbers yet. We need to get the data. We’re just trying to get more information before we make a decision of that magnitude,” she said.

Other practitioners on the Island said they believed they’d be able to take on additional patients and help fill the void Steneker’s departure will create.

“There’s actually a lot of good primary care providers on the Island. … We’re pretty busy. But I think we have room,” said Katie Konrad, a nurse practitioner who works at Dr. Charles Weispfenning’s office. “I think people will be fine. I don’t think it’s a medical emergency.”

Rita Cannell, manager at the Vashon Health Center, the largest clinic on the Island, said her clinic, too, could see additional patients. The health center requires its new Medicare patients to purchase a Medicare Advantage Plan in order to be seen there, but Cannell said she believes the clinic will be able to waive that requirement for Steneker’s patients for a few months — until an open enrollment period that begins in October.

“I’m really sorry this is coming down,” Cannell added. “I don’t know the ins and outs of what happened, but I like to offer people a choice, and the more physicians on the Island, the more choices they have.”